How the Part B deductible works

The Medicare Part B deductible is the amount you must pay out of your own pocket for covered services before Medicare starts to pay its share. For 2024, that deductible is $240 per year. Once you have paid $240 toward covered Part B services, Medicare pays its portion (usually 80%) and you pay your portion (usually 20%) for the rest of the calendar year.

The deductible resets on January 1 each year, so any amount you paid in December does not carry over. The deductible applies to most Part B services — doctor visits, outpatient hospital care, diagnostic tests, and durable medical equipment. It does not explore to preventive services like annual wellness visits, certain screenings, or vaccinations.

You pay the full cost of services until you reach $240. After that, you typically pay 20% of the Medicare-approved amount, and Medicare pays 80%. Some services, like mental health visits, may have different cost-sharing rules even after you meet the deductible.

Key Takeaways

  • The Part B deductible for 2024 is $240 per year, and you must pay this amount before Medicare begins to share the cost of most services.
  • Once you meet the deductible, you usually pay 20% of the cost for covered services and Medicare pays 80% for the rest of that calendar year.
  • The deductible does not explore to preventive services such as wellness visits, cancer screenings, or flu shots.
  • The deductible amount can change each year, so check the current year's amount on Medicare.gov or your Part B notice.

Which services count toward the deductible

Most Part B services count toward your deductible, including doctor office visits, urgent care visits, lab work, X-rays, and other diagnostic tests. If your doctor orders an MRI, CT scan, or ultrasound, those costs count toward the deductible. Physical therapy, occupational therapy, and speech therapy also count. Durable medical equipment — wheelchairs, walkers, oxygen equipment — counts toward the deductible as well.

However, some services are exempt. Preventive services do not count toward the deductible. These include your annual wellness visit, colorectal cancer screening, mammogram, bone density test, diabetes screening, and vaccinations for flu, pneumonia, and shingles. If your doctor finds something during a preventive visit and you need follow-up care, that follow-up may count toward the deductible, but the preventive visit itself does not.

Services that do not count toward the deductible

Preventive care is the main category that skips the deductible. Medicare covers these at no cost to you once you are enrolled in Part B. The list includes the "Welcome to Medicare" preventive visit you can have within your first 12 months of Part B coverage, annual wellness visits in subsequent years, and screenings for cancer, heart disease, and diabetes.

Mental health services have their own rules. Your first mental health visit with a new provider each year does not count toward the Part B deductible. After that, mental health visits do count. Home health services also do not count toward the deductible if they are ordered by your doctor and provided by a Medicare-certified home health agency.

How to track what you have paid toward the deductible

Medicare sends you an Explanation of Benefits (EOB) after each service. The EOB shows what Medicare approved, what you paid, and how much counts toward your deductible. Keep these documents in a folder so you can add up your deductible payments as the year goes on.

You can also check your deductible status online through your Medicare account at Medicare.gov. Log in, go to "Claims," and look for services from the current year. The page will show you how much of your deductible you have met. If you have Original Medicare and a Medigap or Medicare Advantage plan, your plan's website may also show your deductible progress.

If you see a provider who does not accept Medicare assignment, the rules change. That provider can charge you more than the Medicare-approved amount, and the extra charge does not count toward your deductible. Always ask whether a provider accepts Medicare assignment before your visit.

The difference between Part B and Part A deductibles

Part A (hospital insurance) has its own separate deductible, which is different from Part B. For 2024, the Part A deductible is $1,632 per benefit period. A benefit period begins when you enter the hospital and ends when you have been out of the hospital for 60 days in a row. Part A and Part B deductibles do not combine — you must meet each one separately.

If you have a Medicare Advantage plan (Part C), it replaces both Part A and Part B, and the plan sets its own deductible. That deductible may be lower, higher, or structured differently than Original Medicare. If you have Medigap coverage alongside Original Medicare, your Medigap plan may pay some or all of your Part B deductible, depending on which Medigap plan you chose.

What happens if you have other insurance

If you have employer coverage or union coverage while you are on Medicare, that coverage may pay your Part B deductible. The same is true if you have Medicaid or a Medigap plan. The order in which plans pay is called "coordination of benefits," and it depends on the type of coverage you have.

If you have both Medicare and Medicaid, Medicaid may pay your Part B deductible if your income is low enough. If you have a Medigap plan, the plan letter you received when you enrolled will tell you whether it covers the Part B deductible. Plans C, D, G, and M cover the full deductible; other plans cover part or none of it.

When the deductible amount changes

The Part B deductible is adjusted each year based on the increase in Medicare costs. The Centers for Medicare & Medicaid Services (CMS) announces the new deductible amount in the fall, and it takes effect on January 1. You will receive a notice in the mail showing the new amount, or you can find it on Medicare.gov.

Because the deductible changes yearly, the amount you paid toward the deductible in 2023 does not carry over to 2024. Your deductible resets to zero on January 1, and you start fresh with the new year's deductible amount. If you have a Medigap or Medicare Advantage plan, check your plan documents to see how the deductible change affects your out-of-pocket costs.

Frequently Asked Questions

Do I have to pay the Part B deductible every year?

Yes. The deductible resets on January 1 each year, so you must pay it again in 2025, 2026, and every year you have Part B coverage. The amount may change from year to year, but the requirement to meet a deductible does not go away.

What if I only have Part B for part of the year?

You still pay the full annual deductible, not a reduced amount. If you enroll in Part B partway through the year, you are responsible for the full $240 (or whatever the current year's amount is) before Medicare starts to pay its share.

Can my doctor's office tell me if a service counts toward the deductible?

Yes. Before your visit, call the office and ask whether the service counts toward your Part B deductible. If it does, ask what the Medicare-approved amount is so you know roughly what you will owe. Preventive services should not count, but it is worth confirming.

What if I reach my deductible in June — do I pay anything else for the rest of the year?

After you meet the deductible, you pay 20% coinsurance for most Part B services through December 31. You do not pay another deductible until January 1 of the next year. If you have a Medigap plan, it may cover some or all of that 20% coinsurance.

Does the Part B deductible explore to prescription drugs?

No. Prescription drugs are covered under Part D, which has its own separate deductible. Part B deductible and Part D deductible do not combine or affect each other.